How Long Does Perimenopause Anxiety Last?

Perimenopause is a transition that every woman goes through naturally as she moves from her reproductive years into menopause. 

It typically begins in a woman’s 40s but can start earlier or later and last anywhere from a few years to over a decade. 

This phase is characterized by significant hormonal shifts, especially in estrogen and progesterone levels, which affect many aspects of a woman’s body and mind.

While physical symptoms like hot flashes are commonly discussed, another less frequently talked about symptom of perimenopause is anxiety. 

Perimenopausal anxiety can feel overwhelming, affecting emotional well-being, relationships, and overall quality of life. 

For many women, this anxiety isn’t just about feeling a bit nervous or stressed; it can manifest as persistent worry, panic attacks, or emotional instability.

The big question that many women ask is: How long does perimenopause anxiety last? 

Understanding this can be empowering during the menopausal transition, as it helps set realistic expectations and offers insights into managing and reducing anxiety during this time of transition. 

In this article, we’ll dive into why perimenopausal anxiety happens, how long it may last, and actionable ways to manage it, including supplements that support hormone balance and anxiety relief.

Whether you’re in the thick of perimenopause or approaching it, this guide will help you navigate your journey with a bit more clarity and calm.

What is Perimenopause Anxiety?

Perimenopause anxiety refers to the feelings of unease, worry, and tension that many women experience as they go through the hormonal changes associated with perimenopause. 

This phase marks the years leading up to menopause. It includes fluctuating hormone levels, especially estrogen and progesterone. 

These shifts in hormones can have a significant impact on the mind, leading to increased feelings of anxiety and stress.

Symptoms of Perimenopausal Anxiety

The symptoms of perimenopausal anxiety can range from mild to severe and may include:

• A constant feeling of unease, even without a specific trigger.
• Overthinking or feeling like your mind is on a continuous loop of worry.
• Struggling to focus or feeling mentally foggy.
• Anxiety often leads to exhaustion, which can be both physical and mental.
• A racing heart or irregular heartbeat is a common physical symptom of anxiety.
• Trouble falling asleep, staying asleep, or experiencing fitful, restless sleep.
• In some cases, anxiety may escalate into full-blown panic attacks, characterized by overwhelming feelings of fear and also physical symptoms like shortness of breath, sweating, and dizziness.

General Anxiety vs. Perimenopausal Anxiety

While general or chronic anxiety is common and can affect anyone, perimenopausal anxiety is closely linked to the hormonal changes women experience during perimenopause. 

In general anxiety, the triggers could stem from different sources such as work stress, relationship issues, or health concerns. 

However, perimenopausal anxiety is more specifically influenced by fluctuating hormone levels, making it a physiological condition that can feel more intense during certain times of the month or even in response to hormonal imbalances.

Anxiety Perimenopause as a Common Concern

Anxiety during perimenopause is a widely experienced and often under-discussed symptom. It affects many women as they move through this transitional period, but it’s not always recognized or addressed. 

The physical symptoms of perimenopause, such as night sweats, often take the spotlight, leaving anxiety as a silent issue. 

However, understanding that anxiety is a common concern during perimenopause can help women feel less isolated and more empowered to seek solutions. 

By acknowledging the role hormones play in mental health during this stage, women can take active steps to manage their anxiety and find balance.

Why Does Anxiety Happen During Perimenopause?

Perimenopause is a time of hormonal fluctuation, and these changes can have a profound effect on mental health. 

The most notable hormones involved during the menopause transition are estrogen and progesterone. Both have key roles in regulating mood and sleep, as well as overall mental well-being.

Hormonal Changes and Their Effect on Mental Health

As a woman approaches perimenopause, her body begins to produce less estrogen and progesterone. 

This shift in hormone levels can trigger a variety of physical and emotional symptoms. 

Estrogen, for instance, helps to regulate serotonin. 

Serotonin is a neurotransmitter. It plays a key role in mood regulation. As estrogen levels decline, so can serotonin, leading to feelings of anxiety and even depression. 

Progesterone, on the other hand, has a calming effect on the nervous system, and its drop during perimenopause can result in heightened stress responses and emotional instability.

This combination of hormonal imbalances disrupts the natural equilibrium of the brain and body, making women more susceptible to feelings of anxiety, irritability, and mood swings. 

For some women, the mental health symptoms may feel even more intense because their bodies are adjusting to a new, fluctuating hormonal landscape.

The Role of Fluctuating Hormone Levels in Triggering Anxiety Symptoms

The hormonal fluctuations during perimenopause don’t occur in a predictable or steady pattern, and this inconsistency can exacerbate anxiety symptoms. 

The body’s inability to adapt to rapidly changing estrogen and progesterone levels can cause increased sensitivity to stress. 

These fluctuations may also lead to sleep disturbances, which can further aggravate feelings of anxiety. 

Lack of quality sleep disrupts the body’s ability to cope with stress and intensifies mental health symptoms.

These hormonal ups and downs mean that anxiety during perimenopause may not always feel consistent—it might come and go in waves. 

This unpredictability can make women feel as though their anxiety is out of their control, creating a sense of helplessness or frustration.

Perimenopausal Anxiety Worse Before a Period

Many women experience anxiety that worsens right before their period—this is especially common during perimenopause. 

Known as perimenopausal anxiety, worse before the period, this phenomenon occurs due to the natural decline in progesterone levels in the days leading up to menstruation. 

Progesterone typically helps calm the nervous system and maintain emotional balance. 

As levels of this hormone drop before a period, anxiety levels can spike, along with other symptoms like irritability, mood swings, and fatigue.

For some women, this period of heightened anxiety before a period can feel particularly overwhelming, making it more difficult to manage day-to-day life. 

These symptoms may even mimic premenstrual syndrome (PMS), but they are often exacerbated by the hormonal changes occurring during perimenopause, making them more pronounced.

Understanding why anxiety happens during perimenopause, particularly due to fluctuating hormones, can help women take proactive steps to manage mental well-being during this time. 

Recognizing that this anxiety is a natural response to hormonal changes—and not something to feel ashamed of—can be empowering in itself.

How Long Does Perimenopause Anxiety Last?

The duration of perimenopausal anxiety can vary widely from one woman to another, depending on several factors, including hormonal fluctuations, stress levels, lifestyle choices, and overall health. 

While some women may experience brief periods of anxiety, others may feel the effects for years. 

Understanding the factors that influence this anxiety and what a typical timeline might look like can help women manage their symptoms more effectively.

Factors that Influence the Duration of Anxiety During Perimenopause

1. Hormonal Fluctuations: The primary driver of anxiety during perimenopause is the fluctuating levels of estrogen and progesterone. These hormones go up and down from month to month, and some months may be worse than others. During these times, the body’s ability to maintain a stable mood can be compromised, leading to heightened anxiety. If the hormone fluctuations are particularly erratic, anxiety can last longer.
2. Stress Levels: External stressors—such as work pressure, relationship issues, or financial concerns—can amplify anxiety during perimenopause. The added stress, combined with the hormonal changes, can cause anxiety to become more persistent and intense. Managing stress is a big part of reducing the impact of anxiety symptoms during this phase of life.
3. Lifestyle Factors: Diet, exercise, sleep, and self-care play a significant role in managing anxiety. Poor sleep, sedentary behavior, and a diet lacking in nutrients that support hormonal balance (like magnesium, B vitamins, and omega-3s) can prolong or intensify anxiety. Conversely, maintaining a healthy lifestyle with regular physical activity, balanced nutrition, and good sleep hygiene can help mitigate anxiety symptoms and shorten their duration.
4. Health Conditions: Pre-existing conditions, such as depression, panic disorder or generalized anxiety disorder, can make anxiety symptoms during perimenopause more severe or longer-lasting. It’s also important to note that conditions like thyroid imbalances or other hormonal disorders can sometimes mimic or exacerbate the anxiety experienced during perimenopause, potentially lengthening its duration.

Typical Duration of Anxiety Symptoms During Perimenopause

For most women, perimenopausal anxiety typically lasts for the duration of perimenopause, which can range anywhere from a few years to a decade. 

Anxiety might fluctuate in intensity, often peaking when hormonal changes are most pronounced—such as when estrogen and progesterone levels are in the process of dramatically decreasing.

Some women may experience brief bursts of anxiety during perimenopause, while others may deal with low-grade anxiety over a longer period. 

On average, women can expect anxiety to persist as long as they are in perimenopause. 

Once menopause is reached and hormone levels stabilize, anxiety symptoms often subside or become less intense.

How Anxiety Might Vary from Woman to Woman

Anxiety during perimenopause is highly individual, and there’s no one-size-fits-all timeline. 

Some women may experience mild, intermittent anxiety that disappears quickly, while others may struggle with more intense, chronic symptoms for years. 

Factors that can impact the intensity and duration of anxiety include:

• Genetics: Some women may be genetically predisposed to experience higher levels of anxiety, making their perimenopausal anxiety more pronounced and longer-lasting.
• Mental Health History: Women with a history of anxiety or mood disorders may find their symptoms more difficult to manage during perimenopause.
• Coping Mechanisms: Women who have strong coping strategies and emotional support systems may experience less intense anxiety and shorter durations.
• Age of Onset: Women who experience perimenopause earlier than others may have a longer period of anxiety due to extended hormonal fluctuations.

Just as perimenopausal anxiety varies in its duration, it also varies in its intensity. 

For some, anxiety might manifest as occasional nervousness or irritability, while for others, it may feel like a constant cloud hanging over daily life.

Recognizing that perimenopausal anxiety can last anywhere from a few months to several years helps set realistic expectations. 

Managing it with the right tools and support can significantly reduce its impact and provide women with a sense of control during this transitional phase.

Managing Perimenopause Anxiety

Perimenopause can be an emotionally and physically challenging time, but there are several effective ways to manage perimenopausal anxiety. 

Treatment options include both medical interventions like hormone replacement therapy (HRT) and natural approaches such as herbal and vitamin supplements. Understanding how these options work can help you make informed decisions about managing your anxiety.

Hormone Replacement Therapy (HRT) for Menopause Anxiety

Hormone Replacement Therapy (HRT) is a treatment for managing the symptoms of perimenopause and menopause, including anxiety. 

It involves the use of synthetic hormones (estrogen and progesterone) to replace the ones that are declining during perimenopause. 

Hormone therapy’s goal is to restore hormonal balance, which can alleviate the anxiety, mood swings, and irritability that many women experience during this time. Along with helping with anxiety, it may also help with other psychological symptoms, like depressive symptoms.

By stabilizing estrogen levels, HRT can help regulate mood and anxiety levels, offering significant relief for those struggling with mental health symptoms.

Pros of Using HRT During Perimenopause:

• Effective in Managing Anxiety: For many, HRT offers a tool to combat anxiety and mood swings caused by hormonal fluctuations.
• Relieves Other Perimenopausal Symptoms: In addition to anxiety, HRT can help with hot flashes, sweating at night, and sleep disturbances, which can exacerbate anxiety symptoms.
• Improved Quality of Life: For women who find anxiety overwhelming during perimenopause, HRT can provide significant emotional relief and improve overall well-being.

Cons of Using HRT During Perimenopause:

• Potential Side Effects: Some women may experience side effects from HRT, including headaches, nausea, bloating, or breast tenderness. In rare cases, long-term use of HRT may increase the risk of certain health conditions, which can include breast cancer, heart disease, and blood clots.
• Not for Everyone: HRT may not be suitable for women with certain health conditions, such as breast cancer or blood clot history. It’s important to have a conversation with your healthcare provider to figure out if HRT is the right option for you.

When to Consider HRT as a Treatment Option for Anxiety:

HRT may be a good option if your anxiety symptoms are moderate to severe and are affecting your daily life. 

If you have tried other methods without relief, or if you’re also experiencing other perimenopausal symptoms like hot flashes or sleep disturbances, HRT can provide comprehensive relief. 

Supplements for Perimenopause Anxiety and Nausea

In addition to HRT, many women find relief from perimenopausal anxiety through natural supplements. 

Herbal remedies and vitamins can support hormone balance and reduce symptoms of anxiety and nausea. 

These supplements can be a great complement to other treatments or used alone for more mild symptoms.

Herbal Supplements:

1. Black Cohosh
   Benefits: Black cohosh is widely known for its ability to help with hot flashes, night sweats, and anxiety during perimenopause. It helps balance estrogen levels, which in turn can reduce mood swings and anxiety. It’s also widely used for general menopausal symptoms and has been found to be effective by many.
   How It Helps: By mimicking estrogen’s effects on the body, black cohosh supports hormonal balance and relieves perimenopausal anxiety and physical discomfort.
2. Chamomile
   Benefits: Chamomile has calming and relaxing properties. It’s particularly useful for reducing anxiety and improving sleep quality.
   How It Helps: Chamomile can be consumed as a tea or supplement to calm the nervous system, so it becomes easier to relax and fall asleep. It’s a gentle remedy for those who struggle with anxiety, especially before bedtime.
3. Lavender
   Benefits: Lavender is recognized for its ability to reduce anxiety, help with relaxation, and improve sleep.
   How It Helps: Lavender essential oil or supplements can calm the mind and ease feelings of nervousness. It can be used in aromatherapy or taken in capsules to reduce anxiety and improve overall emotional well-being.
4. Ashwagandha
   Benefits: Ashwagandha is an adaptogenic herb that helps the body adapt to stress. It is particularly effective for anxiety management during perimenopause.
   How It Helps: Ashwagandha lowers cortisol levels, reducing stress and anxiety, boosting mood, and promoting mental clarity.
5. Rhodiola Rosea
   Benefits: Known for its mood-enhancing properties, Rhodiola rosea helps combat stress, fatigue, and anxiety.
   How It Helps: Rhodiola improves the body’s resilience to stress by balancing the adrenal glands and supporting hormone regulation. It can elevate mood and reduce the mental fog that often accompanies perimenopausal anxiety.
6. Holy Basil
   Benefits: Holy basil, also known as tulsi, is an adaptogen that helps reduce stress and anxiety and supports hormone balance.
   How It Helps: Holy basil works to lower cortisol levels, balance stress responses, and reduce anxiety. It also supports overall hormone health during perimenopause.
7. Valerian Root
   Benefits: Valerian root is commonly used as a natural remedy for insomnia and also anxiety. It helps improve sleep quality, which in turn reduces anxiety.
   How It Helps: Valerian root has calming effects on the nervous system, making it an effective herb for reducing anxiety and improving sleep during perimenopause.

Vitamins and Nutrients:

1. Magnesium
   Benefits: Magnesium is known for its ability to relieve symptoms of anxiety and calm the nervous system overall.
   How It Helps: Magnesium plays a key role in regulating neurotransmitters and maintaining a healthy mood. It also supports the body’s stress response, making it an essential nutrient for reducing perimenopausal anxiety.
2. Vitamin B6
   Benefits: Vitamin B6 is important for synthesizing neurotransmitters like serotonin and dopamine. These regulate mood and emotional well-being.
   How It Helps: Adequate levels of vitamin B6 can help reduce symptoms of perimenopausal anxiety and improve overall emotional balance.
3. Vitamin D
   Benefits: Vitamin D is needed for mood stabilization and overall mental health, especially during perimenopause.
   How It Helps: Vitamin D levels that are too low have been linked to depression and anxiety. Supplementing with vitamin D can help regulate mood, support immune function, and reduce feelings of anxiety during perimenopause.

Managing perimenopausal anxiety involves a multifaceted approach that includes both medical treatments like HRT and natural supplements to help balance hormones and alleviate anxiety. 

How to Take These Supplements

When considering herbal supplements and vitamins for managing perimenopausal anxiety or menopause symptoms, it’s essential to follow proper dosages, timing, and integration strategies to maximize their effectiveness. 

Here’s how to take these supplements correctly, along with some important tips on safety and potential interactions.

Proper Dosages and Timing for Each Supplement

1. Black Cohosh
   • Dosage: A typical dosage is 20–40 mg, taken 1-2 times daily. Some studies recommend up to 80 mg per day, but starting with a lower dose is advisable to determine your tolerance.
   • Timing: Black cohosh can be taken in the morning or at night, depending on your preference. It’s often taken with food to reduce any digestive discomfort.
2. Chamomile
   • Dosage: Chamomile tea can be consumed 1-3 times daily. If using chamomile supplements, the recommended dose is usually around 200–400 mg per day.
   • Timing: Chamomile is best taken before bedtime for best results. Its calming effects promote relaxation and sleep.
3. Lavender
   • Dosage: Lavender can be taken as an essential oil or as an oral supplement. For oil, a few drops in a diffuser or a few drops of diluted oil applied to the skin can be helpful. For oral supplements, a typical dose is 80–160 mg, taken 1-2 times daily.
   • Timing: Lavender oil can be used throughout the day for relaxation or taken at night to aid in sleep. Oral lavender supplements are best taken with meals.
4. Ashwagandha
   • Dosage: The recommended dosage of ashwagandha root extract is typically between 300–500 mg, taken once or twice a day.
   • Timing: Ashwagandha can be taken in the morning or evening. If it’s used for its stress-reducing effects, it may be better to take it in the evening before bed. If using it for energy or focus, taking it in the morning is ideal.
5. Rhodiola Rosea
   • Dosage: Standard dosages of Rhodiola are typically between 200–400 mg per day, with the most effective doses being taken in the morning.
   • Timing: Because of the stimulating effects, it is best taken in the morning or early afternoon. Taking it later in the day may interfere with sleep.
6. Holy Basil
   • Dosage: The typical dosage for holy basil is 300–500 mg, taken 1-2 times daily. Some products may contain higher doses, so it’s important to follow manufacturer instructions.
   • Timing: Holy basil can be taken with meals or throughout the day to manage stress and anxiety. However, for sleep-related benefits, it may be most effective in the evening.
7. Valerian Root
   • Dosage: Valerian root is commonly taken in doses of 400–900 mg, 30 minutes to an hour before bed, to aid with sleep and anxiety.
   • Timing: As valerian root has sedative effects, it’s best to take it in the evening or just before bed to help with relaxation and promote restful sleep.
8. Magnesium
   • Dosage: Magnesium supplementation typically ranges from 200 to 400 mg daily. If taken as a magnesium citrate or glycinate supplement, 200 mg is often sufficient.
   • Timing: Magnesium is best taken in the evening, as it can help with relaxation and improve sleep quality. It can be taken with or without food.
9. Vitamin B6
   • Dosage: The recommended daily dose for vitamin B6 is usually between 1.3–2.0 mg for adults. However, higher doses (up to 50 mg) are sometimes used for specific conditions.
   • Timing: Vitamin B6 is water-soluble, so that it can be taken at any time of the day. However, to improve absorption, it should be taken with meals.
10. Vitamin D
    • Dosage: The typical dosage of vitamin D is 1,000–2,000 IU daily, though higher doses may be prescribed by a healthcare provider based on blood levels.
    • Timing: Vitamin D is best absorbed when taken with a fat-containing meal. It can be taken in the morning, afternoon, or evening.

Integrating These Supplements into Your Daily Routine

• Consistency is Key: To get the full benefits, consistency is crucial. Set a reminder or create a daily supplement schedule to ensure you take them regularly.
• Meal Timing: Many of these supplements are best absorbed when taken with food. For example, fat-soluble vitamins like Vitamin D should be ideally taken with a meal that includes healthy fats. At the same time, magnesium and ashwagandha are often better absorbed with meals to prevent digestive upset.
• Take in Pill or Capsule Form for Ease: Many of these herbs and nutrients are available in easy-to-take capsules, powders, or tablets, making it easy to incorporate them into your routine. Some herbal teas, such as chamomile, are perfect for a relaxing evening ritual.
• Stay Hydrated: Drink plenty of water throughout the day to help your body absorb the nutrients effectively, especially when taking magnesium, which can sometimes have a laxative effect.

Possible Interactions and Safety Precautions

While herbal supplements and vitamins can be helpful, it’s important to be aware of potential interactions and safety considerations:

• Herbal and Prescription Medication Interactions: Some herbs, like lavender, valerian root, and ashwagandha, may interact with medications such as antidepressants, benzodiazepines, or blood thinners. Always consult with a healthcare provider before starting a new supplement, especially if you are already on medication.
• Avoid Overuse: It’s possible to experience side effects from taking too much of any supplement. For example, too much magnesium can lead to diarrhea, while excessive vitamin B6 can cause nerve damage.
• Pregnancy and Breastfeeding: If you are pregnant or breastfeeding, consult with a healthcare provider before taking any supplements, as some herbs can have contraindications during these times.
• Allergies: If you have allergies, be cautious when taking herbal supplements. For example, lavender may cause allergic reactions in some people. 

Lifestyle Tips to Alleviate Perimenopause Anxiety

While supplements and medical treatments like HRT can significantly alleviate perimenopausal anxiety, lifestyle changes are equally important in managing symptoms and supporting mental health. 

By adopting healthy habits and incorporating stress-relief techniques, you can better navigate the emotional challenges that come with perimenopause.

Stress Management Techniques

Simple practices like yoga, mindfulness, and deep breathing can help activate the body’s relaxation response, bringing relief to the mind and body.

• Yoga combines gentle movement with deep breathing, promoting relaxation and stress reduction. It can lower cortisol (the stress hormone) levels while improving flexibility, strength, and overall well-being. Even a few minutes each day of a regular yoga routine can make a noticeable difference in how you feel.
• Mindfulness: Mindfulness meditation encourages a focus on the present moment, which helps reduce anxiety and promotes calmness. By practicing mindfulness, you can become more aware of your thoughts and feelings but not become overwhelmed by them. Apps like Headspace or Calm are great tools to get started.
• Deep Breathing: Deep breathing exercises can activate the parasympathetic nervous system, counteracting the stress response. Try the 4-7-8 technique: Inhale for 4 seconds, hold your breath for 7 seconds and exhale slowly for 8 seconds. This simple technique can help calm anxiety and improve mental clarity.

Additionally, cognitive behavioral therapy can be helpful for managing mental health conditions, including those stemming from perimenopause symptoms such as severe anxiety.

Regular Exercise and Its Benefits for Mental Health

Exercise is one of the most effective ways to alleviate anxiety. 

Physical activity boosts endorphins, which are natural mood enhancers and can also improve sleep, energy levels, and overall emotional well-being.

• Aerobic Exercise: Activities like walking, jogging, cycling, or swimming can be particularly helpful in relieving anxiety. To experience the full benefits, aim for a minimum of 30 minutes of moderate exercise most days of the week.
• Strength Training: Incorporating strength training into your routine can reduce symptoms of anxiety and improve mood. Lifting weights and doing bodyweight exercises like squats and lunges can help reduce stress and increase feelings of empowerment.
• Mindful Movement: Practices like tai chi or qigong combine movement with deep breathing to promote physical and mental relaxation.

A Balanced, Hormone-Friendly Diet and Hydration for Overall Well-Being

What you eat plays a role in managing perimenopausal anxiety. 

A balanced, nutrient-dense diet can help stabilize blood sugar levels, support hormonal balance, and improve mood.

• Include Healthy Fats: Foods rich in omega-3 fatty acids (like salmon, flaxseeds, and walnuts) can help reduce inflammation and support brain health. Healthy fats also support hormone production, helping to keep estrogen levels balanced.
• Increase Fiber Intake: Fiber-rich foods like vegetables, whole grains, and legumes help keep blood sugar stable and reduce mood swings, preventing crashes that can lead to increased anxiety.
• Stay Hydrated. Dehydration can worsen anxiety and lead to fatigue and irritability. Drink water throughout the day, aiming for at least 8 cups. Herbal teas, like chamomile or peppermint, can also have calming effects.
• Limit Caffeine and Sugar: Both caffeine and high-sugar foods can contribute to anxiety by stimulating the nervous system and causing energy crashes. Try reducing your intake or eliminating them to see if it improves your mental health.

Conclusion

Perimenopausal anxiety can vary greatly from woman to woman. 

Some may experience mild, occasional anxiety, while others may face more severe, persistent symptoms. 

The duration of these symptoms is typically linked to the hormonal fluctuations during perimenopause, lasting anywhere from a few months to several years. 

However, with the right strategies, many women find relief and regain a sense of balance.

Hormone Replacement Therapy (HRT) and herbal supplements can be effective in managing perimenopausal anxiety by stabilizing hormone levels and promoting emotional well-being. 

These treatments can provide significant relief, but it’s also essential to complement them with lifestyle changes like stress management techniques, regular exercise, and a hormone-friendly diet.

By taking a proactive approach to managing perimenopausal anxiety, you can ease symptoms and enjoy a smoother transition through this natural life stage.

Ashley Sutphin Watkins

Ashley Sutphin Watkins is a graduate of the University of North Carolina at Chapel Hill. She's a medical content writer, journalist and an avid researcher of all things related to health and wellness. Ashley lives near the Smoky Mountains in East Tennessee with her family.

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